Provider Demographics
NPI:1467437319
Name:COOPER, STEPHANIE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:E
Last Name:COOPER
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 5TH ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-2903
Mailing Address - Country:US
Mailing Address - Phone:319-337-9996
Mailing Address - Fax:319-353-6923
Practice Address - Street 1:1101 5TH ST
Practice Address - Street 2:SUITE 101
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-2903
Practice Address - Country:US
Practice Address - Phone:319-337-9996
Practice Address - Fax:319-688-9996
Is Sole Proprietor?:No
Enumeration Date:2005-12-14
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA079261223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0214247Medicaid
IA0214247Medicaid
IA19947Medicare ID - Type Unspecified